Kaposi sarcoma (KS) is not typically included in the differential diagnosis of lesions with clinical characteristics of pyogenic granuloma. However, cases of pyogenic granuloma-like Kaposi sarcoma have been reported in the literature. This variant is extremely rare and possesses clinical and histological findings consistent with both conditions. We report an elderly, immunocompetent man with pyogenic granuloma-like Kaposi sarcoma, which was clinically consistent with a pyogenic granuloma and possessed histological findings consistent with Kaposi sarcoma and pyogenic granuloma.

Periungual pyogenic granulomas are benign vascular tumors that present as painful, round, spontaneously bleeding lesions composed of rapidly proliferating capillaries and excess tissue. The vast majority of pyogenic granulomas are caused by physical trauma or infectious agents and they may resolve spontaneously. Herein, we highlight a very rare case of periungual pyogenic granulomas induced by the regularly prescribed oral retinoid acitretin during treatment for congenital palmoplantar keratoderma. This unique case showed that it is feasible to continue acitretin therapy in the presence of pyogenic granuloma development if proper dose reduction and topical therapies are utilized. The patient's lesions resolved within two weeks of this protocol's initiation and the pyogenic granulomas did not recur over the course of a six-month follow-up observation period. In addition, we performed a systematic review of the literature using PubMed databases for the clinical features and treatments in other reported acitretin-induced pyogenic granuloma cases; we compiled a comprehensive list of other prescription drugs known to cause pyogenic granulomas up-to-date.

Pyogenic granulomas are benign lesions commonly found on the skin and mucosal surfaces. Although the etiology of pyogenic granuloma is not well understood, some reports have suggested that PG may be caused by impaired wound healing following tissue injury. Rare cases of pyogenic granulomas in the setting of local foreign body have been reported in the literature. Although foreign body reactions have not been identified as a cause of pyogenic granuloma, these reports evidence the need to further investigate this association. We present a 33-year-old man who presented with a pyogenic granuloma on the scalp six years after a contralateral skull-penetrating gunshot wound that resulted in retained bullet fragments.

There has been increasing interest in minimally invasive approaches to treat pyogenic granulomas. We report successful treatment of a pyogenic granuloma in a pediatric patient on a functionally and cosmetically sensitive area using the 1064nm Nd:YAG laser

Background: Bullous impetigo is a superficial skininfection caused by Staphylococcus aureus (S.aureus). Pyogenic granuloma is a common benigntumor frequently associated with prior trauma.Bullous impetigo and pyogenic granuloma may occurin pregnant women.Purpose: The features of a pregnant womanwith pyogenic granuloma and bullous impetigoconcurrently present in a lesion on her finger aredescribed.Methods: PubMed was used to search the followingterms: bullous impetigo, pregnancy, and pyogenicgranuloma. All papers were reviewed; relevantarticles, along with their references, were evaluatedResults: A red ulcerated nodule with a collaretteof epithelium around the tumor and surroundingbullae appeared on the fifth digit of the left hand of a31-year-old woman who was at 36 weeks gestation. Abacterial culture grew methicillin sensitive S. aureus.An excisional biopsy was performed. Histologicfindings revealed not only a benign vascular tumorwith an infiltrate of mixed inflammatory cells, butalso an intraepidermal blister. She received oralantibiotics and there was complete resolution of thefinger lesion and infection with preservation of digitfunction.Conclusion: Albeit uncommon, pyogenic granulomaand bullous impetigo may concurrently occur in thesame lesion. Therapeutic intervention should focuson treating both the benign skin tumor and theinfection.

Metastases to the face are rare. We report on a patient with a history of renal cell carcinoma who presented with a 1.2cm violaceous papule on his lower lip. Although clinically thought to be a pyogenic granuloma, biopsy revealed metastatic renal cell carcinoma recurring after 7 years of latency.

Importance

Cutaneous pyogenic granulomas (PGs) are commonly encountered, benign, vascular tumors, in which epidemiologic factors have been variably reported, in part, due to sample size limitations and a focus on either adult or pediatric patients.

Objective

To assemble a large dataset of pathologically diagnosed PGs across the continuum of age and investigate patterns of PGs by demographic factors, including age, sex, and anatomical location.

Design, setting, and participants

This retrospective case series included case reports of patients with pathologically confirmed PGs of cutaneous origin reported between April 1, 2010, to March 31, 2020. The pathology database at a large tertiary academic center in the Midwestern US was queried for case reports that included the term pyogenic granuloma or lobular capillary hemangioma. Individuals were included in the analytic sample if they had a pathologically confirmed diagnosis of a PG. PG cases were excluded if they included PG only as a part of the pathological differential diagnoses; were recurrent; or were of noncutaneous origin. These data were analyzed between March 2022 and March 2023.

Main outcomes and measures

The main outcomes were sex biases in frequency overall, by anatomical region, and by left-right laterality using exact binomial tests. Additional outcomes included differences in age-by-sex distribution overall and by anatomical region using Kolmogorov-Smirnov tests.

Results

Of 1009 unique pathologically confirmed PG records from 987 individuals, 376 individuals (38.1%) were younger than 18 years, of whom 122 (32.4%) were female. A total of 611 individuals were 18 years and older, of whom 364 (59.6%) were female. Overall, PGs between male and female individuals were equally distributed for all anatomical locations except lower extremities, in which females were more frequently affected. The distribution of PGs by age was significantly different between male and female individuals, with this difference primarily associated with the head/neck and trunk but not with upper extremity or lower extremity anatomical locations. Neither left-right laterality bias among upper extremity PGs nor anterior-posterior bias among truncal PGs was observed.

Conclusions and relevance

In this retrospective case series, an age-by-sex interaction was found in the incidence of PGs, with PGs on the head/neck and trunk being more common in males younger than 20 years and in females 20 to 50 years of age. These findings suggest that trauma may not be a major etiologic factor for PGs. Future studies are necessary to confirm this and to understand the causes of the age-by-sex interaction.

Peripheral nerve injury has been associated with the development of periungual pyogenic granuolomas (PGs). We present the case of a 39-year-old woman with an eight-month history of periungual PGs in the setting of a four-to-five year history of a traumatic inciting event that produced symptoms consistent with complex regional pain syndrome (CRPS). Although recurrent, these periungual PGs have remitted after treatment with topical timolol maleate. This case exhibits an underappreciated association between peripheral neurologic abnormalities, which include CRPS, and cutaneous abnormalities. It also presents evidence that supports the concept that PGs that are not appropriate for surgical treatments may be treated with topical timolol maleate.

Notable milestones in the treatment of vascular lesions have been achieved over the past century. Many cutaneous vascular lesions can be successfully treated with lightbased devices. In this review, we will discuss the treatment of port-wine birthmarks, lymphatic malformations, infantile hemangiomas, rosacea, venous lakes, pyogenic granulomas, cherry angiomas, and angiofibromas using lasers, total reflection amplification of spontaneous emission of radiation, intense pulsed light, and photodynamic therapy. In addition, for several of these diagnoses, we will review medical therapies that can be combined with light-based devices to provide enhanced results.